Persistent Depressive Disorder (Dysthymic Disorder)

An estimated 1.5% of adults in the United States suffer from persistent depressive disorder, also known as dysthymic disorder. It is considered a relatively new diagnosis and essentially combines two earlier diagnoses, dysthymia and chronic major depression, to describe a continuous, long-term type of depression that can last years, negatively impacting your relationships, school, work, and daily activities. Coping with persistent depressive disorder can be difficult because it is chronic in nature, however, some combination of talk therapy (psychotherapy) and medication are proven to help with treatment and managing symptoms.

Dysthymic Disorder Signs and Symptoms

Despite the fact that it is a milder form of depression, persistent depressive disorder still has a significant impact. A wide range of symptoms, common to all types of depression, can be experienced by someone with a persistent depressive disorder. As the symptoms are milder and last longer, it’s more difficult for the patient to deal with the long-term effects of this diagnosis. The signs of persistent depressive disorder usually come and go over multiple years and the intensity can change, with major depression episodes occurring intermittently.

Adults suffering from dysthymic disorder may experience the following signs and symptoms, which are all too common:

  • Hopelessness
  • Sleep problems
  • Avoiding social activities
  • Lack of interest in daily activities
  • Sadness, emptiness, or feeling down
  • drowsiness and exhaustion
  • Low self-esteem, self-criticism or feeling incapable
  • Having difficulty focusing and making decisions
  • Anger, irritability, or a pessimistic outlook
  • Reduced output, efficiency, and effectiveness
  • Poor appetite or overeating as a result of guilt and worry about the past

In children and adolescents, symptoms of a persistent depressive disorder, such as irritability, moodiness, or pessimism, can be expected to show up for long periods of time. These individuals may seem easily agitated and have performance and behaviour issues in a school environment that vary over time. It is also important to note the main indication for an adult with this disorder differs somewhat from that of a child. It takes at least two years for an adult to be depressed, while it takes a year for a child to be depressed or irritable.

What Causes Persistent Depressive Disorder?

Individuals who have dysthymic disorder may wonder why and how they have come to experience the illness. While the cause is not widely known or fully understood, there are a variety of factors that can contribute to the development of mental health disorders. Each of these factors work together to reinforce common symptoms of depression and can even heighten a person’s feelings of stress. These include:

  • Inherited traits or a history of the condition in one’s family
  • Traumatic life experiences and feelings of isolation
  • Is it a medical condition or is it just chronic stress?
  • A chemical imbalance in the brain
  • Ineffective ways of dealing with stress and other difficulties Taking Control of Your Stress
  • Physical brain trauma

If left untreated, there are complications linked with persistent depressive disorder that can negatively impact a person’s quality of life. Substance abuse, family strife, suicidal ideation, chronic pain and illness, and decreased performance at school or work are just a few of the problems that these people face. Consider treatment and prevention options to help limit the disorder’s further complications.

How to Prevent Persistent Depressive Disorder

Dysthymic disorder prevention does not have a magic, silver bullet, but there are a few strategies that can help prevent the further development of certain symptoms. A person’s stress and resilience can be improved by taking certain steps, which can help them deal with difficult situations in the future. Reaching out to family and friends during particularly difficult times can also help a person weather the hard moments.

The most important thing to remember is that seeking treatment for a persistent depressive disorder as soon as symptoms appear can help manage and prevent further symptoms from developing. Long-term maintenance treatment may be necessary to keep symptoms from returning. The best way to start treatment is by seeking a diagnosis from a doctor or psychiatrist.

Diagnosis of Long-Term Depression

When a person decides to seek treatment for their chronic depression, a few steps in the diagnosis process are required. A doctor may administer a few different types of exams and self-evaluations, including:

  • Examination by a physician. To figure out what’s causing the depression, a doctor may perform a physical exam and ask probing questions about the patient’s health. In some cases, it may be linked to an underlying physical health problem.
  • Lab tests. Other medical conditions that may cause depressive symptoms may be ruled out by a doctor through the use of laboratory tests. For example, they may order a blood test to find out if an individual’s thyroid is underactive (hypothyroidism) (hypothyroidism).
  • Evaluation of one’s mental health. This may entail a questionnaire to elicit information about your thoughts, feelings, and behaviours. There are a variety of conditions that can negatively impact mood, including major depression, bipolar disorder, and seasonal affective disorder. This assessment can help determine if a person has persistent depression disorder or another of these conditions.

Adults must have a depressed mood for the majority of the day, nearly every day, for at least two years before being diagnosed. The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, may also be used in the diagnosis of persistent depressive disorder. Anyone diagnosed with dysthymic disorder will likely be referred on to a mental health professional for further assessment and treatment.

Treating Persistent Depressive Disorder

Chronic depression is typically treated with a combination of medication and talk therapy after a proper diagnosis has been made. As each patient’s symptoms and preferences vary, as well as how the diagnosis is affecting his or her quality of life and previous treatments, a doctor will work with him or her to determine the best treatment strategy.


Despite the fact that medication is generally considered to be a more effective treatment option, the most successful treatments typically include a combination of both therapy and medication. Persistent depression is typically treated with one of the following antidepressants, prescribed by either an in-person or an online psychiatrist:

  • Tricyclic antidepressants (TCAs), such as amitriptyline (Elavil) and amoxapine, such as fluoxetine (Prozac) and sertraline (Zoloft) (Asendin)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as desvenlafaxine (Pristiq) and duloxetine (Cymbalta) (Cymbalta)

It’s critical to discuss any potential side effects with your doctor or pharmacist before starting any medication. Sometimes a person will need to try a few different medications and dosages to find the best solution, and this process may take several weeks and months for its complete effect. The medication should not be stopped abruptly without consulting a physician first, as this could worsen any existing depressive symptoms.


An individual suffering from a persistent depressive disorder will engage in psychotherapy with an appropriately trained mental health professional, also known as talk therapy or psychological counselling. Cognitive behavioural therapy (CBT) is one type of therapy that can be used to treat chronic depression, and a therapist will work with each patient to determine which type of therapy is best for him or her, as well as how long it will take.

CBT can be done individually or in a group setting. Support groups can be a good place to talk to people who are going through the same things you are. Individuals with a persistent depressive disorder may benefit from talking therapy in many ways, including the development of the following abilities:

  • Adjust to a crisis or other current difficulty
  • Identify issues that contribute to depression and change behaviours that make it worse
  • Replace unhealthy, negative beliefs and behaviours with healthy, positive ones by doing the following:
  • Find better ways to cope and solve problems
  • Develop positive interactions with others by learning about other people’s relationships and experiences.
  • Restore a sense of well-being and alleviate depression’s accompanying symptoms, such as rage.
  • Acquire the ability to set goals that are both reasonable and feasible.

Managing Persistent Depressive Disorder Symptoms Long-term

Persistent depressive disorder, or dysthymic disorder, is a chronic and long-term mental health issue, and some individuals may never fully recover from it. Treating persistent depressive disorder can be difficult because of its long-term nature, however, some combination of talk therapy (psychotherapy) and medication is proven to help with managing symptoms. A person’s ability to function in social situations, academics, the workplace, and the rest of daily life is jeopardised if they do not seek treatment for their persistent depressive disorder. Seeking a diagnosis is the first step to acknowledging the illness and properly treating it.

Think about talking to a Talkspace therapist if you believe you have dysthymic disorder — it’s an easy and affordable way to get started today.

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